CARTOM Mail Order Form Print-Out

Or use the the "Money Order, Check, VISA or Mastercard" option in the Shopping Cart Set printer for pages from:1 to 1.
CLICK HERE FOR ORDER INSTRUCTIONS
Date:__________________
Name:___________________________________
Address:__________________________________
City:_______________________State/Province:__________ZIP/Postal Code:___________
Country:_____________________
Phone:______________________ and, or E-Mail:__________________________________
Where relevent, please state size along with color!
__________________________________________________________________________
Product    | Color |Product Item Number |Quantity | Price Each |Total Price           
___________|_Size__|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________
           |       |                    |         |            |            
___________|_______|____________________|_________|____________|____________

                                                  |  Sub-Total |
_________________________________________________________________________
                                                  | Ohio S. Tax|
_________________________________________________________________________
                                                  | TOTAL      |
_________________________________________________________________________
CHECK or MONEY ORDER payable to REGOL-G INDUSTRIES
Send your order to:
REGOL-G INDUSTRIES
P.O. Box 10832
Cleveland, Ohio 44110
CREDIT CARD INFORMATION:
Please check CREDIT CARD TYPE: Master Card_____ VISA______
Account Number: |__|__|__|__| - |__|__|__|__| - |__|__|__|__| - |__|__|__|__|
Card Holder's Name:____________________________________ Card Expires:________
Card Holder's Signature:__________________________________ Date:__________
Please allow up to 2 to 3 weeks for delivery.
THANK YOU for your order.
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